What is Herald Patch?
A herald patch is a distinct mark on the skin, characterized by a single, red, round or oval patch or raised flat area. The skin patch has a depressed (lowered) middle area with a raised edge, and it usually varies from about an inch to four inches wide. The patch usually appears on the neck, chest, or back. As it changes over time, the center of the patch tends to clear up, leaving only the outside edge of the patch.
This leads to a unique “collarette” of scale, which is like a circular collar of flaky skin – a common first sign of a common skin condition called pityriasis rosea. Pityriasis rosea is a benign rash that often resolves on its own over time. The edge of the patch can also look somewhat like the edge of a cigarette paper directed inward toward the center.
The name herald patch, or “mother” patch, is given because it often shows up several days to 2 weeks before the full outbreak of pityriasis rosea. However, interestingly, in 10% to 50% of pityriasis rosea cases, this initial patch may not be present, particularly in instances where the condition is caused by medication. Also, the patch may appear in more than one place and unusual spots, such as the bottoms of the feet or scalp. Sometimes, the herald patch may be the only symptom of the disease, without a following rash.
What Causes Herald Patch?
The cause of the herald patch and pityriasis rosea, common skin conditions, is believed to be linked to the human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) infections, but this is still a matter of debate. Support for this theory comes from the fact that outbreaks tend to happen in groups, most people experience specific symptoms before the herald patch or pityriasis rosea rash appears, and these conditions rarely happen more than once in an individual, indicating possible immunity.
Other viruses like human herpesvirus 8 (HHV-8), the 2009-2010 pandemic H1N1 influenza A virus, and the virus causing COVID-19 (SARS-CoV-2), have been associated with the occurrence of pityriasis rosea.
In a retrospect study, pityriasis rosea was found to reoccur in only 3.7% of patients and in these rare cases, the herald patch did not reappear. Some scientists believe that the interaction between certain types of immune cells in the skin could play a role in the development of these conditions, but there’s no confirmation if these interactions are due to a viral cause.
In some cases, pityriasis rosea has been observed after vaccinations for diseases such as smallpox, tuberculosis, flu, HPV (human papillomavirus), polio, tetanus, diphtheria, pneumonia, hepatitis B, and yellow fever. It has also been reported in connection with the COVID-19 vaccines recently.
Lastly, certain medications, like acetylsalicylic acid (Aspirin), barbiturates (used for anxiety), bismuth (used for stomach issues), and others have been observed to occasionally cause skin rashes looking like pityriasis rosea.
Risk Factors and Frequency for Herald Patch
Pityriasis rosea is a skin condition that often starts with a single large spot known as a herald patch, present in about 80% of cases. It typically affects people aged between 20 and 29, but it can occur at any age. While it’s slightly more common in females, pityriasis rosea can affect both genders. The condition tends to be more frequent during spring and fall in places with moderate climates. People of all races can get the condition. However, it’s worth noting that in people with dark skin, particularly those of African descent, the condition might result in more widespread dark spots, different from the rose-colored spots that often appear in fair-skinned individuals.
Signs and Symptoms of Herald Patch
Pityriasis rosea is a skin condition that often begins with a large, red, scaly spot known as the “herald patch”. This patch usually appears on the trunk, neck, or upper body, but can sometimes occur on the face or other areas. It is typically round or oval and ranges in size, but it can be very large in rare cases.
Some people may experience symptoms like headache, fever, body aches, and tiredness before or during the time that the herald patch appears. Within a few days to two weeks after the herald patch shows up, patients may develop a more widespread skin rash. This rash consists of smaller spots that look like the herald patch and appear in a “Christmas tree” or “fir tree” pattern, most often on the torso.
The rash tends to grow from top to bottom over several days. After about four to six weeks, the rash generally fades. It may leave behind some discoloration of the skin. Some patients with pityriasis rosea have also been reported to develop abnormalities in the mouth, such as red spots, flat areas, or raised spots.
Pityriasis rosea can appear in different forms, including the classic type, relapsing type, persistent type, and forms that occur in children, pregnant women, and those that look like pityriasis rosea but are actually caused by other conditions.
Testing for Herald Patch
Before the full outbreak of pityriasis rosea, sometimes known as the “herald patch,” it can be tricky to diagnose this skin condition. Usually, there are no abnormal lab test results associated with this skin disease. However, because it looks very similar to ringworm (tinea corporis), your doctor might need to examine skin flakes under a microscope using a substance called potassium hydroxide (KOH) to help tell the two conditions apart.
If the KOH test doesn’t provide a clear answer, your doctor might take a small sample of your skin (a biopsy) to help figure out if the herald patch is due to ringworm, erythema annular centrifugum (a rare, ring-shaped skin rash), or nummular eczema (a type of eczema that causes coin-shaped patches of irritated skin).
After the full pityriasis rosea rash appears, your doctor should also check your palms and the soles of your feet. This is because the rash can sometimes look like the rash seen in secondary syphilis. If there’s any chance you could have syphilis, additional tests like the rapid plasma reagin (RPR) test may be needed to confirm the diagnosis.
Treatment Options for Herald Patch
The ‘herald patch’ is a characteristic feature of a skin condition called pityriasis rosea. This condition is generally harmless and goes away by itself. Usually, no treatment is required, and both the herald patch and the rest of the rash caused by pityriasis rosea should disappear within 8 weeks. However, people often look for treatment because the rash can be itchy, or they might be concerned by how the rash looks. While most people with pityriasis rosea don’t have symptoms or just mild itchiness, around 25% of patients can experience severe itchiness.
If the rash causes discomfort or is bothersome, the following advice can help:
– Firstly, patients and their caregivers should be reassured that pityriasis rosea typically resolves on its own within 2 to 3 months. There’s a low risk of passing it on to others, and it’s uncommon for it to return. It’s also important to avoid scratching and contact with irritants, such as harsh soaps, synthetic fabrics, fragrances, hot water, tight clothing, and sweating.
– A doctor may recommend applying a medium-strength topical steroid cream to the itchy areas 2 or 3 times a day for about 2 or 3 weeks. However, long-term use should be avoided to prevent thinning of the skin, a potential side effect of prolonged steroid use.
– Lotions that have a soothing effect, such as those containing pramoxine, menthol, calamine, or zinc oxide, may help to reduce itchiness.
– Oral antihistamines can be used to lessen irritation and can also help patients to sleep better at night if the itchiness is disrupting their sleep.
– Although oral steroids like prednisolone can potentially improve the itchiness of pityriasis rosea, their routine use is not advised due to lack of solid evidence regarding their effectiveness and concerns about the rash coming back after stopping the treatment.
– The suspected link between pityriasis rosea and certain types of herpes viruses has led to researchers studying the use of oral acyclovir, an antiviral medication. However, we need more high-quality research to confirm its potential benefits.
– Ultraviolet B phototherapy and a 2-week course of the antibiotic erythromycin have been shown to shorten the duration of the rash.
– Intensive UVA1 phototherapy is associated with less severe symptoms and better control of itchiness.
– Trials of the antibiotics clarithromycin and azithromycin for pityriasis rosea show that these treatments are typically ineffective.
What else can Herald Patch be?
The “herald patch” is a single skin lesion that is often confused with other skin conditions. Thus, when identifying its nature, doctors typically need to distinguish it from conditions like:
- Tinea corporis (ringworm of the body)
- Nummular eczema (circular patches of irritated skin)
- Erythema annulare centrifugum (a type of skin rash)
One way to tell these conditions apart is by observing where the scaly parts of the skin are located within the red, irritated area. The “herald patch” and “erythema annulare centrifugum” often have a trailing scale. This looks like a ring of flaky skin inside the edges of the red area. The edge of the scale in ringworm can appear to lead the red area in a circular manner. Nummular eczema typically has flaky skin throughout the lesion without any empty space in the center.
In cases where the “herald patch” develops into a full case of pityriasis rosea (a rash that usually begins as a large circular or oval spot on the chest, abdomen, or back), the doctors would then consider other conditions such as:
- Secondary syphilis (a stage of syphilis)
- Guttate psoriasis (a type of psoriasis that shows up as small, salmon-pink bumps on the skin)
- Tinea versicolor (a fungal infection that causes small, discolored patches of skin)
- Pityriasis lichenoides chronica (a rare, chronic skin condition featuring small, scaling bumps)
- Lyme disease
- HIV
- Seroconversion illness (the period during which HIV antibodies start to appear)
- Drug rashes
Testing for HIV should be conducted in patients who have risk factors for or symptoms indicating HIV infection.
What to expect with Herald Patch
The first sign of pityriasis rosea – a skin condition – is often a large, round or oval patch of skin, known as the herald patch. The outbreak of this herald patch and the subsequent rash should clear up on its own within about 8 weeks. However, some reports have described a persistent form of pityriasis rosea that can last longer, sometimes even more than 12 weeks.
The herald patch is seen in most cases of this condition. People with this symptom often have more systemic symptoms like body-wide discomfort or disturbances, development of sores in the mouth, and higher levels of certain viruses (HHV-6 and HHV-7) within their bodies.
It’s important to note that it’s quite rare for the condition to come back (relapse) after it has completely cleared up – this happens in only about 2% of cases.
Possible Complications When Diagnosed with Herald Patch
: Dark skin individuals often experience a condition known as post-inflammatory hyperpigmentation, a consequence of skin inflammation. This condition can take several months, or even longer, to get better.
A link between pityriasis rosea, a type of skin rash, and pregnancy complications has been suggested but remains unclear due to conflicting research. Some studies indicate that the occurrence of this skin disease during pregnancy might increase the risk of miscarriage.
However, other research doesn’t show any notable difference in miscarriage rates between pregnant individuals with and without pityriasis rosea. There are also studies suggesting that extensive or long-lasting pityriasis rosea, appearance of the rash earlier in pregnancy, or the presence of additional symptoms outside the skin could potentially lead to adverse pregnancy outcomes, such as premature birth, low birth weight, or spontaneous abortion.
On the contrary, some research finds the timing of the skin disease onset to be unimportant in causing any pregnancy complications. Thus, more research is needed to definitively understand how pityriasis rosea impacts pregnancy.
Typical Risks in Pregnant Individuals with Pityriasis Rosea:
- Increased risk of miscarriage
- Potential for premature delivery
- Possibility of low birth weight in babies
- Unfavorable outcomes in extensive or prolonged cases
- Unknown implications depending on the timing of the disease onset
Preventing Herald Patch
If you have pityriasis rosea, which starts with a single large patch on your skin and is followed by a rash, it’s important to know that this condition will typically improve on its own and cannot be passed on to others. The main focus of treatment is to help manage symptoms, particularly the itchiness that comes with the rash. It’s best to avoid scratching the affected areas and stay away from anything that might irritate your skin.
